Providers - Prior review
Your plan for better healthSM1

Diagnostic imaging procedures

The following services may require prior approval when received on a non–emergent outpatient basis, such as in a doctor’s office, the outpatient department of a hospital or at a freestanding imaging center 1 (for dates of service on or after February 15, 2007):

  • CT/CTA scans
  • MRI/MRA scans
  • PET scans
  • Nuclear cardiology studies
  • Echocardiography

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Diagnostic imaging prior approval code list:

The following document outlines the health services codes for diagnostic imaging procedures.

Diagnostic imaging prior approval code list

Please Note: The procedure code 76380, limited CT, does not require authorization. However, CT of the maxillofacial: procedure codes 70486, 70487 and 70488 do require authorization. Please be sure you are using the proper code for the service being provided.

To request prior approval for diagnostic imaging procedures:

  • Online – Through the ProviderPortalSM system in Blue eSM
  • By phone: American Imaging Management – 1–866–455–8414
    Monday – Friday, 8 a.m. – 6 p.m., Eastern Time

Please note: Only ordering physicians can obtain a prior approval number. Hospitals and freestanding imaging centers that perform the services listed cannot obtain a prior approval number but should confirm that one was issued.

Diagnostic imaging resources:

1 Prior approval is not required when services are performed in an emergency room, hospital (related to an inpatient stay), urgent care center or ambulatory surgical center.